Healthcare Provider Details

I. General information

NPI: 1366942468
Provider Name (Legal Business Name): KAREN HEE SONG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUPERDRUG OKA 285 FARENHOLT AVENUE STE#304
TAMUNING GUAM
96913
UM

IV. Provider business mailing address

SUPERDRUG OKA 285 FARENHOLT AVENUE STE#304
TAMUNING GUAM
96913
UM

V. Phone/Fax

Practice location:
  • Phone: 671-646-6177
  • Fax: 671-649-2724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH077
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: